MEDICARE: VASCULAR & THORACIC ASSOCIATES OF LOS ANGELES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A32316	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CB224234	OTHER	CA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295706901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASCULAR & THORACIC ASSOCIATES OF LOS ANGELES

Provider Business Mailing Address
First Line	:	3680 E IMPERIAL HWY
Second Line	:	SUITE 502
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2659
Country	:	US
Telephone Number	:	562-698-0271
Fax Number	:	562-698-7467

Provider Business Practice Location Address
First Line	:	3680 E IMPERIAL HWY
Second Line	:	SUITE 502
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2659
Country	:	US
Telephone Number	:	562-698-0271
Fax Number	:	562-698-7467

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE SPIWAK
Credential	:	M.D.
Telephone Number	:	562-698-0271

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/26/2015

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Directions to “VASCULAR & THORACIC ASSOCIATES OF LOS ANGELES ” Practice Location

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